DOING BUSINESS
Post-Procedure Payment Negotiations Know when to open a dialogue and when to stay the course. BY BARBARA CATALETTO
When a case performed at your ASC has been pre-authorized, your ASC is
not contracted with the carrier and you have
already explained this to the patient who has accepted responsibility for the balance due, you are not obligated to negotiate with a carrier. But when a negotiated agreement can speed up the payment process, reduce the liabil- ity of your patient or protect your ASC from an audit or refund in the future, you may want to discuss alternative payment options. The information that follows can help you decide when the time is right and conduct a successful negotiation when you do.
1. How long has the claim been outstanding and waiting for payment? “What,” you might ask, “does that have to do with nego- tiations?” If the claim has already been out for review and pending payment for three months, you might not want to work with the carrier and might simply demand immediate payment instead. If, however, the claim has been out- standing for a reasonable amount of time, say 30 days or less, you might consider negotiating.
2. How can a negotiation affect the timeliness of the payment your ASC receives? Say you have ex- perience with a certain carrier who holds up certain claims for extend- ed periods of time going through a “high dollar review” process. You can shorten the time it takes to get paid by negotiating with the car- rier to produce payment within a designated period of time. Never- theless, you should never agree to
any payment that is not considered acceptable just to ensure early payment.
3. What is your minimum expected payment? Before you enter into negotiations, you need to have a clear number that identifies the minimum expected payment for any procedure or case. The nego- tiation company has a minimum and maximum before they begin communicating with any practice or facility, and you must do the same. Know your minimum and the industry maximum before you sign on the dotted line. Never ac- cept the first negotiation as that is the beginning number for these companies. Do not fret that you will not get another offer. Nego- tiation companies can never guar- antee payment above the policy
28 ASC FOCUS NOVEMBER/DECEMBER 2013
provisions, so you can be sure that any first offer is well below policy obligation. Hold off until you have reached your minimum expected payment before agreeing to the payment offered by the company.
4. How can I ensure that my ASC is able to make the most of all the benefits that negotiation might offer? When you are considering negotiating a lower reimburse- ment after a procedure has already been performed, perks available to your ASC include prompt pay- ment and the reduction of refund or retraction risks. Begin by tell- ing the carrier/negotiator that you have other items that need to be added into the agreement. First, dictate how long the carrier has to make good on the agreement, e.g., 10 days, 14 days, 5 business days;
The advice and opinions expressed in this article are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.
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